Field Note

Going and Remaining Where Others are Afraid to Go
Dr. Juan Manuel Canales

The right to health care is a basic right that is assiduously ignored, abused and violated world wide, especially among marginalized and excluded communities in conflict zones. The 2006 winner of the Jonathan Mann Award for Global Health and Human Rights, Dr. Juan Manuel Canales has spent 25 years assisting poor peasant and indigenous communities in El Salvador and Chiapas, on the Mexico-Guatemala border, to demand their right to health care. Amidst the violence of civil war and military oppression, Dr. Canales has calmly and tirelessly continued his work, building community health services and speaking out against the violations of human rights.

Volunteering as a physician in El Salvador during the 1980s, Dr. Canales trained young health promoters to address the broad health needs of their communities - a concept that was contrary to traditional physician-based curative care. He lived and worked in heavy conflict areas where right-wing death squads roamed and the military confiscated medicines, destroyed clinics and targeted based health care workers as subversives. Canales collected data on violations of medical neutrality and trained villagers on their international legal rights to medicines and medical care. The violence eventually caught up with him, however, leaving Canales with a loss of vision in his left eye and a permanent limp resulting from a leg injury.

Canales remained in El Salvador after the end of the civil war in 1992, working closely with the Pan American Health Organization and other groups to aid returning refugees and establish mental health programs for traumatized communities. He began to use community radio as a public health tool working extensively with health promoters and midwives to develop simple radio dramas that were humorous, but effective and engaging to teach about human rights and health.

Since 1999, Canales has turned his attention to practicing community development, health and human rights among the politically oppressed, but fiercely independent populations of indigenous Mayans in Chiapas, Mexico. Canales goes back and forth across heavily militarized zones, facing tactics of intimidation and roadblocks. “There is no more courageous or peace-with-justice living person,” said Dr. Clyde Smith, of Montefiore Medical Center. His leadership style is to go where others fear to go, demanding excellence of others by providing a role mode with his own actions while listening quietly, learning and working very, very hard.”

Canales understands that an outsider can serve only as a catalyst and conduit for a community's own drive for health and justice. He brings unbounded enthusiasm and creativity to his work, while knowing that the ultimate focus of his activities must come from the people he serves. In training health promoters, Dr. Canales takes a “low-tech” approach, the only teaching aid at his disposal, usually an old chalkboard and relies on the use of “dinámicas,” or active small-group discussions, to engage his students. Since many health promoters are illiterate, his creativity has been essential for effective teaching. He has also learned to speak Tzeltal, a local Mayan language. To assist the women with their cooperative, he has educated himself on running a small business. In these activities, he is always eager to learn new things, and thus serves as an example to others.

The Jonathan Mann Award for Health and Human Rights is presented annually to a leading organization or individual in health and human rights, working often at great personal risk. The $15,000 cash prize allows its recipients some freedom to pursue their work. The award was initiated in 1999, following Dr. Jonathan Mann's untimely death in 1998. This award continues the legacy of this remarkable individual and highlights the vital link between health and human rights. The first director of the World Health Organization's Special Program on AIDS from 1986-1990, Dr. Mann pioneered the approach to AIDS that continues to shape public health policy today and articulated the ways in which the health of individuals and populations reflects access to basic human rights. The award is jointly supported by Association François-Xavier Bagnold, Doctors of the World, John Snow, Inc. and the Global Health Council, and selected by a blue ribbon committee.